Ask the doctor - uneven breasts

My daughter is 18 and one of her breasts is bigger than the other. The larger one is heavy and lumpy. She is too embarrassed to go to her GP.

It’s common for one breast to be bigger than the other during development, and for them to even out by the end of puberty. If your daughter’s asymmetric breasts are causing psychological distress, she may be able to have an operation. But as one breast is lumpy, it’s important she seeks medical advice urgently. Reassure her that GPs are used to dealing with conditions like this – she can ask to see a female doctor.
Dr Sarah Brewer, Prima (Feb 12)

My son likes dressing in his sister’s clothes. Should I try to get him to change when we go out, and how worried should I be? He is five.
Children start to pick up on conventions and rules about ‘what boys do’ and ‘what girls do’ from around the age of two, as soon as they start to understand that there is a difference between the two genders. By the age of three, children are able to identify themselves clearly as boys or girls, and are beginning to grasp social conventions about how boys or girls – including themselves - should act and dress. By the age of four, they are still unaware that gender is constant, and believe it is possible to swap sex as easily as changing clothes. It’s not until the age of around five that a child understands appearances can be deceiving. Your son may be pretending he is a girl, or still believe he has turned into a girl by dressing in girls’ clothes. This is nothing to worry about – both beliefs are a normal part of development and learning about gender. Some parents impose strict rules, such as ‘boys don’t wear pink’ while others are against gender-specific toys, clothes and colours. Do whatever you feel comfortable with, although if your son is teased by friends for wearing his sister’s clothes, he’ll probably decide for himself not to wear them outside the home.
Dr Sarah Brewer, Prima (Feb 12)

I was horrified to notice a small bald patch on my scalp recently. The hairdresser says it will go on its own, but it seems to be spreading. Is there any treatment?

Individual patches of hair loss (rather than thinning at the crown, receding hairline, etc) are often caused by a condition called alopecia areata, which affects 1 in 60 people over a lifetime. It tends to cause one or more round patches of complete hair loss on the scalp, which can also be itchy. It’s more common in people who have diabetes, thyroid problems or a skin condition called vitiligo, suggesting that it may have an auto-immune cause (when the body’s immune system turns on itself). It’s often linked with stress, although it’s not clear if stress causes the hair loss or the other way round. It’s worth asking your GP to test your thyroid function and iron levels – even a mildly underactive thyroid or low iron may make the condition worse. Make sure your diet has enough so-called first-class proteins – lean meat or fish – and rest assured that most people only lose a single patch of hair, which tends to regrow on its own within a few months.
Dr Sarah Jarvis, Good Housekeeping (Jan 12)

I’d like to tell your readers not to ignore symptoms similar to recurring thrush. This happened to me and after a biopsy I was found to have VIN stage three which, if left untreated, can turn into cancer.
A VIN, or vulval intraepithelial neoplasia, is a skin condition affecting the external female genitals. Symptoms include itching, soreness, burning and tingling sensations. Sometimes skin changes are seen too, such as changes in colour, but in some women there are no obvious symptoms. If you have recurrent problems in this area, seek advice from your doctor or from your local genito-urinary medicine clinic, which you can find by visiting www.fpa.org.uk.
Dr Sarah Brewer, Prima (Nov 11)

For the past five years, I’ve suffered daily with wind. I can feel the gasses building up after lunch. The only time I don’t get wind is if I’m prescribed antibiotics. What else can I do?
Wind builds up when bowel bacteria ferment undigested fibre and sugars that reach the large bowel. Antibiotics kill off some bowel bacteria, so can reduce wind temporarily. One common cause of wind is lactose intolerance, where you no longer produce enough of the enzyme lactase, needed to break down milk sugar. As you can’t absorb it, lactose is fermented by bowel bacteria to cause symptoms such as bloating, audible bowel sounds (borborygmi), wind, cramping abdominal pains and sometimes diarrhoea. Lactose sugar is naturally present in sheep’s, cows’ and goats’ milk in similar quantities. Your doctor can refer you for tests to confirm the diagnosis and rule out other bowel problems. Try avoiding milk products and instead use low-lactose cows’ milk, such as Lactofree (around £1.23 per litre, from supermarkets) or milks made from soy, nuts or rice.
Dr Sarah Brewer, Prima (Jul 11)

My daughter keeps getting head lice, and last time I treated her it didn’t work. I hate the thought of using strong chemicals – she’s only six. What should I do?
Head lice are an incredibly common problem dreaded by every parent of primary school children. They can only be caught by head-to-head contact and, contrary to urban myth, are every bit as likely among children with clean hair as dirty! We don’t recommend that you treat head lice unless you can see live lice, though – they’re grey-brown and about the size of a sesame seed. No treatment is 100% successful, and resistance against some medications that work by poisoning head lice has been an issue. There are now several products containing dimeticone, which kills lice by depriving them of oxygen – so resistance is less of an issue. However, you do need to check everyone in the family with a nit comb when anyone gets head lice, and treat everyone who’s affected at the same time. With most products, you’ll probably need a second treatment a week later, as eggs can survive the initial treatment and cause another infestation when they hatch.
Dr Sarah Jarvis, Good Housekeeping (Apr 11)

Head lice are rife at my children’s school. How often should I wet comb to get rid of them?
When wet, lice close their air tubes and lie still, which makes them easier to detect and comb out. Wet-combing conditioned hair with a lice comb for at least 30 minutes every three to four days, for two weeks, is around 60 per cent effective at removing newly hatched lice and nits (eggs), but you only have to miss one fertilised adult female for the infestation to start up all over again. One of the most effective natural treatments is Hedrin Once Liquid Gel (£7.49 from pharmacies). Apply to dry hair and leave on for at least 15 minutes before shampooing off. Trials show it kills all lice and eggs after just one treatment. Check everyone in your family regularly, as not everyone with headlice develops the allergic reaction that leads to itching. For more information, visit onceaweektakeapeek.com.
Dr Sarah Brewer, Prima (Feb 11)

We recently came back from holiday with our daughter and her family, and I've discovered I've got head lice. Not surprisingly, I'm horrified. I shall have to tackle her about it, but wanted to find out more first.
I'm glad you have asked - head lice, or nits, are a very thorny subject for parents. Sadly, today they're a common problem in children - and their families - regardless of geography or hygiene habits. Head lice are not killed by shampooing or conditioning, so frequent washing offers no protection. The lice can't jump, fly, or survive for long on pillows or furniture, so they spread by walking from head to head. That means that any decent cuddle from a mother or granny, as well as a playground game with a friend, carries a risk. However, I would suggest the risk is more than worth it - just talk to your pharmacist about lotions and nit combs, and alert your daughter, because she'll have to treat the whole household.
Dr Sarah Jarvis, Good Housekeeping (Aug 09)

I'm 35 and recently I've noticed that I'm sweating a lot more. It's really knocking my confidence, especially when I wear close-fitting clothes and sweat patches appear. I've tried strong deodorants, but to no avail. Is there anything I can do?
Excessive sweating can really affect your self-esteem. As it's a new problem, I would suggest seeing your doctor for a check up as medical conditions, such as diabetes and hyperthyroidism (an overactive thyroid), can lead to excessive sweating. The other big physical problem is obesity, so knowing your BMI (body mass index) score would be useful. If you're overweight (a BMI of over 25), then simply losing weight may sort out your problems. It is also important to deal with any sources of anxiety and depression as these can affect sweat levels. In terms of antiperspirants, the best ones are those that contain aluminium chloride, such as Driclor (£5.98 from Boots) or Anhydrol Forte (£3.89 from pharmacy2u.co.uk). These are applied at night and washed off in the morning. Use them every day at first, then reduce usage according to your response.

If you are looking for a longer effect, you could consider Botox injections in the underarm area. These have been shown to last about six months and while they won't stop sweating completely, they should reduce it substantially. For a permanent solution patients have traditionally been offered an ETS (endoscopic transthoracic sympathectomy), which involves cutting the nerves that control sweating. It is not without its potential complications and you may find that the sweating is simply transferred to another part of your body. More recently, a new surgery technique has been developed that is available privately at some clinics. Called Laser Sweat Ablation, it claims to cure about 70 per cent of patients. Under local anaesthetic, a laser is used to destroy the sweat glands in the armpit, then the glands are removed through a small hole. The main advantages are that it is less invasive and has a quicker recovery than ETS. For more information visit sweating.co.uk
Dr Louise Selby, SHE (July 09)

The answers to specific problems may not apply to everyone and are not substitutes for professional medical advice. If you're worried, see your GP. For more information, visit netdoctor.co.uk